Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020.

Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths from stroke. The seventh update of the Canadian Stroke Best Practice Recommendations includes a new stand-alone module on intracerebral hemorrhage, with a focus on elements of care that are unique or affect persons disproportionately relative to ischemic stroke. Prior to this edition, intracerebral hemorrhage was included in the Acute Stroke Management module and was limited to its management during the first 12 h. With the growing evidence on intracerebral hemorrhage, a separate module focused on this topic across the care continuum was added. In addition to topics related to initial clinical management, neuroimaging, blood pressure management, and surgical management, new sections have been introduced addressing topics surrounding inpatient complications such as venous thromboembolism, seizure management, and increased intracranial pressure, rehabilitation as well as issues related to secondary management including lifestyle management, maintaining a normal blood pressure and antithrombotic therapy, are addressed. The Canadian Stroke Best Practice Recommendations (CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke and to promote optimal recovery and reintegration for people who have experienced stroke, including patients, families, and informal caregivers.

A Feasibility Study Involving Recruitment and Screening for Aphasia in Acute Stroke: Emerging Viability of the English Adaptation of the Language Screening Test (LASTen).

OBJECTIVES: We describe recruitment feasibility for language screening in acute stroke using the English adaptation the Language Screening Test (LASTen), originally developed in French. We also elucidate preliminary measurement properties of LASTen in patients with and without aphasia. DESIGN: Prospective eligibility tracking, recruitment, and screening for aphasia using the 2 parallel forms, LASTen-A and LASTen-B. SETTING: The Neurovascular Unit and the Transient Ischemic Attack and Minor Stroke Unit of a tertiary care hospital. PARTICIPANTS: Stroke patients (N=12) with hyperacute to subacute stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Numbers of eligible patients and recruitment viability, individual performance indicators for both LASTen versions (15 points each) in 12 patients grouped by aphasia status, and reliability of the 2 parallel forms. RESULTS: There were 25 eligible stroke patients over 1 month. All 12 recruited patients consented to testing. The patients ranged in age from 29 to 85 years, and 5 were women. Three patients had intracerebral hemorrhage, and 6 had aphasia (mild to severe). The median LASTen scores in patients with and without aphasia were 10 (interquartile range, 8) and 15 (interquartile range, 0), respectively. Five patients had discrepant scores across versions involving a 1-point difference. One patient with aphasia had a 5-point difference, demonstrating improvement on the second version. The Pearson correlation coefficient was 0.95 for parallel form reliability. CONCLUSIONS: Our study confirmed that LASTen appears to function as designed. There was score heterogeneity for patients with aphasia and desired ceiling effects for those without aphasia, alongside excellent parallel form reliability. The findings provide the impetus for a large-scale diagnostic accuracy trial in acute stroke patients.